Common Surgical Procedures Gyn/Oncology

Common Surgical Procedures Gyn/Oncology

Malignancy Cervical

Cervical

Description Typical Open Cone biopsy Leep conization Colposcopy/Leep TAH +/- BSO Radical hysterectomy +/- BSO Pelvic lymphadenectomy (Total, bilateral) Para-aortic sampling Radical trachelectomy +/-BSO Pelvic lymphadenectomy (Total bilateral) Para-aortic sampling Less Common Open Radical vaginal hyst (Schauta)

Cervical

Radical vaginectomy Partial removal wall Radical vaginectomy Partial removal wall Pelvic lymphadenectomy (Total bilateral) Para-aortic sampling Radical vaginectomy Complete removal wall Radical vaginectomy Complete removal wall Pelvic lymphadenectomy (Total bilateral) Para-aortic sampling Pelvic lymphadenectomy External iliac Hypogastric/Obturator Laparoscopic Radical hysterectomy +/- BSO Pelvic lymphadenectomy (Total bilateral) Para-aortic sampling Pelvic lymphadenectomy (Total bilateral) Pelvic lymphadenectomy (Total bilateral) Para-aortic sampling

Codes wRVU

Comments

57520 57522 57461 58150 58210

4.11 3.67 3.43 17.31 30.91

Includes excision of parametria and ureteral dissection. Can be used for TAH PLND

57531 29.95

58285

57107 57109

23.38

24.56 28.40

Includes excision of parametria and ureteral dissection Modifier 52 fertility sparing +/- nodes Includes removal of paravaginal tissue Partial Vaginectomy use 57106 Includes removal of paravaginal tissue

57111 57112

28.40 Includes removal of paravaginal tissue Complete vaginectomy 57110

30.52 Includes removal of paravaginal tissue

38770 14.06 Use modifier 50 for bilateral procedure 58548 31.63

38571 38572

14.76 16.94

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Common Surgical Procedures Gyn/Oncology

Malignancy Endometrial

Endometrial Endometrial

Description Open TAH +/- BSO TAH +/- BSO P&P sampling Radical hysterectomy +/- BSO Pelvic lymphadenectomy (Total, bilateral) Para-aortic sampling TAH/BSO Omentectomy Debulking TAH/BSO Omentectomy Debulking Pelvic lymphadenectomy Limited para-aortic lymphadenectomy TAH/BSO Omentectomy TAH/BSO P&P nodes Omentectomy Laparoscopic LAVH 250gms LAVH BSO TLH 250gms TLH BSO Laparoscopic Nodes Retroperitoneal sampling Pelvic lymphadenectomy (Total bilateral) Pelvic lymphadenectomy (Total bilateral) Para-aortic sampling

Codes wRVU

Comments

58150 58200

17.31 23.10

58210

30.91 Includes excision of parametria and ureteral dissection. Can be used for TAH PLND

58953 34.13

58954 37.13

58956

5821022

22.80 Code indicates used for malignancy only 30.91 Increase fee to reflect use of modifier 22

58550 58552 58553 58554 58570 58571 58572 58573

38570 38571

38572

15.10 16.91 20.06 23.11 15.88 17.69 20.09 23.11

9.34 Single or multiple nodes 14.76

16.94 Single or multiple nodes

2

Common Surgical Procedures Gyn/Oncology

Malignancy Ovarian/ Peritoneal

Open

Description

Oophorectomy P&P node sampling Peritoneal biopsies/washings +/- salpingectomy +/- omentectomy BSO Omentectomy TAH/BSO Omentectomy Pelvic lymphadenectomy Limited para-aortic lymphadenectomy BSO Omentectomy Debulking (radical dissection)

Ovarian/ Peritoneal

TAH/BSO, Omentectomy Debulking (radical dissection) TAH/BSO Omentectomy Debulking (radical dissection) Pelvic lymphadenectomy Limited para-aortic lymphadenectomy TAH/BSO Omentectomy Debulking +/- omentectomy Debulking +/- omentectomy Pelvic lymphadenectomy Limited para-aortic lymphadenectomy Staging (second look) +/- omentectomy Biopsy abd/pelvic Pelvic and limited para-aortic lymphadenectomy Laparoscopic

Second look with biopsy With nodes Staging

Codes wRVU

Comments

58943

58950 58951

19.52

Partial or total oophorectomy, unilateral or bilateral Specific for ovarian, tubal, or primary peritoneal malignancy

18.37 24.26

Initial resection of ovarian, tubal, or primary peritoneal malignancy Initial resection of ovarian, tubal, or primary peritoneal malignancy

58952 58953

27.29 34.13

Initial resection of ovarian, tubal, or primary peritoneal malignancy Radical excision/destruction intraabdominal or retroperitoneal tumors All sites

58954 37.13 All sites

58956 58957 58958

22.80 All sites 26.22 Recurrent gyn resection 29.22 Recurrent gyn resection

58960

15.79 Specific for ovarian, tubal, or primary peritoneal malignancy

49321 38572 49320 38572

5.44 16.94

5.14 16.94

No codes for debulking: unlisted 22 modifier as appropriate

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Common Surgical Procedures Gyn/Oncology

Malignancy Vaginal

Description Open Vaginectomy, partial Vaginectomy, partial Removal of paravaginal tissue (radical) Vaginectomy, partial Removal of paravaginal tissue (radical) Bilateral total pelvic lymphadenectomy Para-aortic lymph node sampling Vaginectomy, complete Vaginectomy, complete Removal of paravaginal tissue (radical) Vaginectomy, complete Removal of paravaginal tissue (radical) Bilateral total pelvic lymphadenectomy Para-aortic lymph node sampling Biopsy of vaginal mucosa, simple Biopsy of vaginal mucosa, extensive

Destruction of lesion(s), simple Destruction of lesion(s), extensive

Code wRVU

57106 57107

7.50 24.56

57109 28.40

Comments

57110 57111

57112

15.48 28.40

30.52

57100 57105

57061 57065

1.20 1.74 Requires sutures

Includes cysts 1.30 2.66

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Common Surgical Procedures Gyn/Oncology

Malignancy Vulvar

Vulvar

Description Simple: removal of skin and superficial subcutaneous tissue Radical: removal of skin and deep subcutaneous tissue Partial: Removal of 80% vulvar area Open Vulvectomy, simple, partial Vulvectomy, simple, complete Vulvectomy, radical, partial Vulvectomy, radical, partial Unilateral inguinofemoral lymphadenectomy Vulvectomy, radical, partial Bilateral inguinofemoral lymphadenectomy Vulvectomy, radical, complete Vulvectomy, radical, complete Unilateral inguinofemoral lymphadenectomy Vulvectomy, radical, complete Bilateral inguinofemoral lymphadenectomy Vulvectomy, radical, complete Inguinofemoral lymphadenectomy Iliac lymphadenectomy Pelvic lymphadenectomy Biopsy vulva or perineum; 1 lesion

Biopsy of each additional lesion vulva or perineum Excision benign lesion of genitalia

Excision malignant lesion of genitalia

Intermediate repair code genitalia

Code wRVU

Comments

56620 56625 56630 56631

56632

56633 56634

56637

56640

7.53 9.68 14.80 18.99

21.86

19.62 20.66

24.75

24.78

56605 +56606

1.10 0.55 Add on code. Use with 56605

1142011426

1162011626

1204112047

Varies by code

Varies by code

Varies by code

Based on excised diameter. Use if skin not excised.

Based on excised diameter. Use if skin not excised.

Use in conjunction with 11420-11426 and 11620-11626 if layered closure required

5

Common Surgical Procedures Gyn/Oncology

Malignancy Bowel Procedures Partial Colectomy

Open

Description

Partial colectomy with anastomosis

Partial colectomy Skin level cecostomy or colostomy Partial colectomy End colostomy and closure of distal segment (Hartmann type procedure) Partial colectomy Resection, with colostomy or ileostomy Creation of mucofistula Partial colectomy Coloproctostomy (low pelvic anastomosis) Partial colectomy Coloproctostomy (low pelvic anastomosis) Colostomy Partial colectomy Abdominal and Transanal approach

Total Colectomy

Enterectomy

Mobilization (take-down) of splenic flexure Colectomy, partial Removal of terminal ileum with ileocolostomy Colectomy, total Ileostomy or ileoproctostomy Total colectomy Continent ileostomy Total colectomy Proctectomy Ileostomy Total colectomy Proctectomy Continent ileostomy Total colectomy Proctectomy Ileoanal anastomosis, Total colectomy Proctectomy Ileoanal anastomosis Creation of ileal reservoir (S or J) Small bowel resection Each additional resection and anastomosis Small bowel resection Enterostomy

Code wRVU

Comments

44140 22.59 44141 29.91 44143 27.79

44144 29.91

44145 28.58 44146 35.30

44147 33.69

+44139 2.23 Add on code. Use with 44140-44147 44160 20.89 44150 30.18 44151 34.92 44155 34.42

44156 37.42

44157 35.70 Includes loop ileostomy, and rectal mucosectomy, when performed

44158 36.70 Includes loop ileostomy, and rectal mucosectomy, when performed

44120 20.82 +44121 4.44 Add-on code. Use with 44120

44125 20.03

6

Common Surgical Procedures Gyn/Oncology

Malignancy Bowel Procedures

Laparoscopic

Description

Laparoscopic enterectomy Single resection of small intestine Anastomosis

Each additional small intestine resection and anastomosis Laparoscopic partial colectomy Anastomosis Laparoscopic partial colectomy Removal of terminal ileum Ileocolostomy Laparoscopic partial colectomy End colostomy and closure of distal segment (Hartmann type procedure) Laparoscopic partial colectomy Coloproctostomy (low pelvic anastomosis) Laparoscopic partial colectomy Coloproctostomy (low pelvic anastomosis) Colostomy Laparoscopy mobilization (take-down) of splenic flexure

Code wRVU

Comments

44202 23.39

+44203 4.44 Add-on code. Use with 44202

44204 26.42 44205 22.95

44206 29.79

44207 31.92 44208 33.99

+44213 3.50 Add-on code. Use with 44204-44208

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Common Surgical Procedures Gyn/Oncology

Malignancy Other Procedures

Other Procedures

Open

Description

Exploratory laparotomy Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, 1 or more peritoneal, mesenteric, or retroperitoneal primary or secondary tumors; largest tumor 5 cm diameter or less

Largest tumor 5.1-10.0 cm diameter Largest tumor greater than 10.0 cm diameter Appendectomy;

For indicated purpose at time of major procedure Enterolysis

Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis

Laparoscopy

Diagnostic laparoscopy Laparoscopy with biopsy Laparoscopy with aspiration of cavity or cyst (single or multiple) Laparoscopic appendectomy

Laparoscopic enterolysis

Code

49000 49203

49204 49205 44950 +44955 44005

50715

49320 49321 49322 44970 44180

wRVU

Comments

12.54 20.13

Includes biopsies if performed Codes appropriate when primary organs have been removed. If ovarian tumor, use appropriate ovarian tumor or BSO code.

26.13 30.13 10.60 1.53 18.46

20.64

Add-on code. Report in addition to primary surgical procedure Designated as (Separate procedure). Generally not reported in addition to other surgical codes. If enterolysis is extensive, may report with 59 modifier Must have diagnosis of retroperitoneal fibrosis to report. Typically, ureterolysis is included in major surgical procedure.

5.14 5.44 Use for ovarian biopsy 6.01 Use for aspiration of ovarian cyst

9.45 15.27

There is not an add-on code for laparoscopic appendectomy Designated as (Separate procedure). Generally not reported in addition to other surgical codes. If enterolysis is extensive, may report with 59 modifier

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